AB0262 PATIENTS WITH RHEUMATOID ARTHRITIS WHO DEVELOP SARCOPENIA FALL FREQUENTLY: 5-YEAR DATA FROM THE CHIKARA STUDY
Authors: Y. Yamada, M. Tada, K. Mandai, N. Hidaka, H. Nakamura
Journal: Annals of the Rheumatic Diseases (2022)

Background Patients with rheumatoid arthritis (RA) are likely to have sarcopenia due to decreased muscle mass and physical function. Some patients develop sarcopenia even if disease activity is well-controlled. We previously reported that 13.2% of RA patients without sarcopenia at baseline developed sarcopenia over a year 1 . Objectives The aim was to longitudinally investigate sarcopenia status and the characteristics of RA patients using data from the prospective, observational CHIKARA study. Methods Body composition, laboratory data, disease activity, physical function (HAQ), treatment, and history of falls and fractures were investigated in 100 RA patients who participated in the CHIKARA study at baseline and at 5 years. They were divided into 4 groups depending on their sarcopenia status: no sarcopenia developed (N group; sarcopenia absent at baseline and 5 years); sarcopenia developed (S group; sarcopenia absent at baseline, but present at 5 years); cured (C group; sarcopenia present at baseline, but absent at 5 years); and persistent (P group; sarcopenia present at baseline and at 5 years). Results Seventy RA patients completed the survey. There were no differences among the 4 groups in disease activity, physical function, and treatment. The N group, accounting for 67.1% of all patients, was young and had high body mass index, muscle mass, fat mass, estimated bone mass, and body metabolic rate at baseline. On the other hand, the S group, accounting for 4.3% of all patients, fell significantly more frequently (p=0.035), 3.3 times during 5 years. The P group, accounting for 18.6% of all patients, had significantly higher MMP-3 at baseline (p=0.006). The C group accounted for 10.0% of all patients (Table 1). Table 1. Characteristics of 77 RA patients by sarcopenia status at baseline and at 5-year follow-up no development (n=47) development (n=3) cured (n=7) persisted (n=13) p value age, years 63 (57.5, 70) 76 (74.5, 81) 66 (54, 70) 73 (65, 82) 0.006 disease duration, years 6.5 (1.1, 10.7) 15.2 (14.9, 20.7) 11.4 (7.2, 14.8) 3.5 (1.1, 6.5) 0.021 MTX dose, mg/day 8.1 ± 3.7 6.0 ± 2.0 7.4 ± 3.8 6.2 ± 4.8 0.406 biologics use, % 36.2 66.7 28.6 23.1 0.513 GC use, % 23.4 0 28.6 15.4 0.701 average GC dose, mg/day 3.5 ± 1.1 0 3.7 ± 1.8 6.3 ± 1.8 0.833 CRP, mg/dl 0.1 (0.04, 0.18) 0.04 (0.04, 0.23) 0.2 (0.12, 0.47) 0.19 (0.08,0.82) 0.22 MMP-3, ng/ml 62.2 (50.3, 98.6) 58.9 (47.8, 71.3) 74.9 (58.3,147.2) 160 (90.8,262) 0.006 DAS28ESR 3.34 ± 0.91 4.11 ± 0.72 3.36 ± 1.38 3.79 ± 1.20 0.355 mHAQ 0.25 (0, 0.5) 0.63 (0.56, 1.25) 0.87 (0.25, 1.0) 0.25 (0.13, 0.75) 0.132 BMI, kg/m 2 23.22 ± 3.51 21.4 ± 2.25 18.69 ± 2.08 19.56 ± 2.39 &lt;0.001 SMI, kg/m 2 6.73 ± 0.7 6.1 ± 0.2 5.51 ± 0.14 5.79 ± 0.6 &lt;0.001 fat percentage, % 30.39 ± 8.77 30.03 ± 9.12 25.04 ± 6.23 23.75 ± 6.56 0.051 estimated bone mass, kg 2.2 (2, 2.4) 1.9 (1.75, 1.95) 1.6 (1.55, 1.9) 1.9 (1.7, 2.2) 0.001 BMR, kcal 1101 (1051, 1198) 986 (934, 1010) 896 (872, 994) 978 (902,1107) &lt;0.001 ΔDAS28ESR -0.15 ± 0.84 -0.43 ± 1.73 0.04 ± 0.89 -0.59 ± 1.33 0.445 ΔSMI, kg/m2 -0.06 ± 0.34 -0.38 ± 0.57 0.25 ± 0.22 0.08 ± 0.42 0.038 fall, times 1.6 3.33 1.29 0.38 0.045 Data are shown as mean ± standard deviation (SD) or median (25th, 75th percentile). GC: glucocorticoids, MMP-3: matrix metalloproteinase 3, DAS: disease activity score, HAQ: health assessment questionnaire, BMI: body mass index, SMI: skeletal muscle mass index, BMR: body metabolization rate, Δ:change during 5 years. Conclusion Overall, 4.3% of RA patients developed sarcopenia and fell frequently during 5-year follow-up. Patients who develop sarcopenia require special care because they are at high risk of falls. References [1]Y Yamada, M Tada, K Mandai et al. Glucocorticoid use is an independent risk factor for developing sarcopenia in patients with rheumatoid arthritis: from the CHIKARA study. Clin Rheumatol 2020 Jun;39(6):1757-1764. Disclosure of Interests None declared